Migraine

Lady with migraine
Migraine has been plaguing human beings for thousands of years.(1) It was first recorded by Hippocrates in around 400 BC, and was more fully described by Galen in the second century AD.(1) In the 17 th century the physician Dr Thomas Willis thought that the pain of migraine is due to expansion of the blood vessels in the brain.(1) This has been found to be incorrect but the concept still persists today.

“Causes of the Migraine.”

Migraine itself is a common problem that can be very disabling for its sufferers.(2) Twenty percent of the Australians suffer from migraine.(6) In about 20% of people it starts with what is known as an aura.(2) This is normally changes in vision like spots, shapes or flashing lights and may increase to be a blind spot. It is thought to be due to a phenomena called cortical spreading depression (CSD). In CSD the nerve cells fire in a wave like pattern across areas of the brain after which there is a long lasting decrease in their firing.(2) It is thought to be caused by faulty firing of nerve cells (see below).(2) In people who get an aura including other symptoms such as pins and needles, numbness and or weakness, the CSD is thought to take place in areas related to those functions in the brain.(2) In those who do not get an aura, it is thought that CSD occurs in areas of the brain that do not have obvious outputs and hence are “silent”.(2) CSD activates the nerve fibres that carry pain messages from the coverings around the brain and its blood vessels.(5) Local inflammation makes the blood vessels more permeable(5), and this allows substances in that cause inflammation.(2) The nerve fibres are part of what is called the trigeminovascular system and when these are stimulated it can reproduce the pain of migraine.(5) They can also further cause inflammation through a process called neurogenic inflammation.(2)

An Oversensitive Brain.

When normal individuals are presented with a stimulus of some kind (eg. light, sound etc.), the first response from the brain to stimulus is always the greatest. After the first stimulus the brain effectively starts to ignore the stimulation in a process called habituation. In migraine sufferers it has been found that the part of the brain that receives sensation inputs (the sensory cortices) are functioning at a decreased level, that is their preactivation level is decreased.(3) Also they do not habituate, and in some cases the brain’s response to stimulation actually increases, especially when the stimulus is stronger.(3) It is thought that the ability of the brain to restrict this input fatigues.(3) The restriction is generated in the lower parts of the brain and in special neurons in the cortex of the brain.(3)

It has also been found with studying migraine patients that they have subtle cerebellar deficits, possibly due to slight dysfunction on genetically abnormal calcium channels.(4) The Cerebellum is an area of the brain that controls and co-ordinates movement and thought as well as having a large input into gut function and other things. A group of researchers(4) found hypermetria or increased movement. This is linked to dysfunction in the lateral cerebellum, which produces impaired braking of movements, resulting in hypermetria. Surprisingly migraine patients had better targeting (an intermediate cerebellar function based on feedback loops). It is not known why this is the case, but is thought that it may be a compensation.(4) These abnormalities were more pronounced in patients with an aura to their migraine.(4)

Relief from Migraine.

Food sensitivity can often be a cause of migraine. It is thought that the chemicals in certain foods affect the chemistry of the sufferer, either triggering or making the individual more susceptible to an attack. Tyramine (in cheese), phenyl ethylamine (in chocolate), tyrosine, monosodium glutamate, gluten, aspartame, caffeine, sulphites, nitrates (in bacon, ham salamis etc) and histamine (in beer and wine)(6) are all substances thought to be involved. Cheese, chocolate, red wine and beer all have strong associations.(7) A first approach should be to exclude the most common triggers and gradually reintroduce each food separately, noting any adverse reactions.

Sleep disorders have been found to affect central nervous system function, not only in migraine(7) , but also in problems such as ADHD/ADD and other neurobehavioural disorders.(8,9) In one study the treatment of sleep disorders in patients whose headaches either began during the night or on waking resulted in improvement in all cases and complete resolution in 65%.(10) Behavioural treatments for sleep can often be helpful such as sleep/headache diaries, progressive relaxation training and proper sleep hygiene.(11)

Spinal adjustments and massage or other soft tissue therapies have been found to be helpful by many patients. These can help in several ways.

1. They can increase the nerve signals from the body going into the brain. This helps stabilise the brain.
2. They can help increase signals going into the cerebellum making it healthier.
3. They can decrease the pain input into the system making it less likely to be stimulated.

Don’t just live with it.

Migraine is not something that you just have to live with, nor do you have to be restricted to taking medication to combat it. Call our centre on 03 9435 2887 , or send us a message using the form below, to see what we can offer you.

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  1. Dodick, D. A Plague of Pain: Migraine’s Long Road to Respect. Cerebrum. The DANA Foundation. (www.dana.org) July 2001
  2. Buzzi MG, Moskowitz MA. The pathophysiology of migraine: year 2005. J Headache Pain 2005 6:105-111
  3. Schoenen J. Neurophysiological features of the migrainous brain . Neurol Sci 2006 27:S77-S81
  4. Sandor PS, Mascia A et al. Subclinical cerebellar impairment in the common types of migraine: A three dimensional analysis of reaching movements. Ann Neurol 2001;49:668-672
  5. Bolay H, Reuter U. Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nature Medicine Feb 2002 8(2):136-142
  6. Woolhouse M. Migraine and tension headache. Australian Family Physician Aug.2005 34(8):647-651
  7. Peatfield RC. Relationship between food, wine and beer: precipitated migrainous headaches. Headache 1995;35:355-7
  8. Hill Cm, Hogan AM et al. Increased cerebral blood flow velocity in children with mild sleep-disordered breathing: A possible association with abnormal neuropsychological function. Paediatrics 2006;118;e1100-e1108
  9. Mitchell RB, Kelly J. Behaviour, neurocognition and quality-of-life in children with sleep-disordered breathing. International Journal of Paediatric Otorhinolarynography 2006;70:395-406
  10. Paiva T, Farinha A et al. Chronic headaches and sleep disorders. Arch Intern Med. 1997 Aug 11-25;157(15):1701-5
  11. Rains JC, Poceta JS. Sleep and headache disorders: Clinical recommendations for headache management. Headache 2006;46[Suppl 3]:S147-S148
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